Neuro - cranial nerves

Question 1

Order

Answer 1

Inspection
I
II
III, IV, VI
V
VII
VIII
IX, X
XI
XII

Question 2

Olfactory

Answer 2

Any recent change in sense of smell?

Question 3

Optic

Answer 3

Acuity - (ensure wearing glasses if needed) cover one eye and read line from ID badge/newspaper (or Snellen chart if available), then repeat with other eye

Accomodation - focus point past me, then look to my finger when I say (pupil should constrict)

Fields - sit opposite patient, one arm length away. Cover opposite eyes, look at my nose and say when you can see finger moving
- inattention - say which side you see moving

Reflexes - direct and consensual response to light in pupil

(fundoscopy, papilloedema)

Question 4

Occulomotor, Trochlear, Abducens

Answer 4

Follow finger in H shape at limits of eye movement (DON’T MOVE HEAD)
Ask if any double vision, look for nystagmus

III palsy -> down and out pupil, ptosis, dilated pupil (Horner’s sign)
IV palsy -> slightly up and out pupil
VI palsy -> can’t laterally abduct

Question 5

Trigeminal

Answer 5

Sensation - eyes closed, each side in opthalmic, maxillary and mandibular divisions
(can you feel it, is it the same on both sides?)

Clench teeth, feel masseter and temporalis

Question 6

Facial

Answer 6

Expressions:

• raise eyebrows
• puff out cheeks (don’t let me push them in)
• screw up eyes (don’t let me open them)
• show me your teeth

Question 7

Vestibulocochlear

Answer 7

Rub fingers next to ear, can you hear this

Rinne’s test - 512 (small) tuning fork, can you hear against mastoid process? Can you hear by ear? (shoule be ear better)

Weber test - 512 (small) tuning fork in middle of forehead, can you hear, louder on one side?
(if louder on right, either conductive hearing loss on right, or sensory loss on left)

Romberg test - balance

Question 8

Glossopharyngeal and Vagus

Answer 8

Any difficulty swallowing?

Watch swallow of water, symmetry

Open mouth, aaah, look for uvula symmetry (deviates away from lesion)

Question 9

Accessory

Answer 9

Shrug shoulders up, don’t let me push them down (trapezius)

Turn head against my hand (sternocleidomastoid)

Question 10

Hypoglossal

Answer 10

Stick out tongue (look for fasciculation/deviation, deviates towards lesion)

Push tongue into cheeks, press against